Operative management of fragility fractures of the pelvis – a systematic review
Abstract Background The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate...
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| Format: | Article |
| Language: | English |
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BMC
2021-08-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-021-04579-w |
| _version_ | 1819096590573371392 |
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| author | Daniel G. G. Wilson Joshua Kelly Mark Rickman |
| author_facet | Daniel G. G. Wilson Joshua Kelly Mark Rickman |
| author_sort | Daniel G. G. Wilson |
| collection | DOAJ |
| description | Abstract Background The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention. Methods A systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. Seventeen eligible studies were identified with 766 patients. Results The quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A number of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed. There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients. Conclusions Operative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications. PROSPERO Systematic Review ID: CRD42020171237. |
| first_indexed | 2024-12-22T00:01:37Z |
| format | Article |
| id | doaj.art-a83fa23cd87e4602a057fc620164df1e |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-22T00:01:37Z |
| publishDate | 2021-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-a83fa23cd87e4602a057fc620164df1e2022-12-21T18:45:41ZengBMCBMC Musculoskeletal Disorders1471-24742021-08-0122111310.1186/s12891-021-04579-wOperative management of fragility fractures of the pelvis – a systematic reviewDaniel G. G. Wilson0Joshua Kelly1Mark Rickman2Royal Adelaide HospitalRoyal Adelaide HospitalRoyal Adelaide HospitalAbstract Background The incidence of osteoporotic pelvic fractures in elderly patient is rising. This brings an increasing burden on health and social care systems as these injuries often lead to prolonged hospital admissions, loss of independence, morbidity and mortality. Some centres now advocate stabilisation of these injuries to reduce pain, facilitate early mobilisation, decrease hospital stay and restore independence. A systematic review of the literature was planned to establish the evidence for this intervention. Methods A systematic review was performed according to PRISMA guidelines. A clinical librarian performed a search of the following databases: NHS Evidence, TRIP, the Cochrane Database of Systematic Reviews, MEDLINE and EMBASE. Seventeen eligible studies were identified with 766 patients. Results The quality of evidence was poor with no good quality randomised trials. The majority of injuries were minimally displaced. Posterior ring injuries were most often stabilised with percutaneous screws which were sometimes augmented with void filler. A number of techniques were described for stabilisation of the anterior ring although fixation of the anterior ring was frequently not performed. There was consistent evidence from the included studies that operative intervention significantly improved pain. Complications were minimal but there were increased failure rates when a single unaugmented sacroiliac joint screw was used. The limited availability of non-operative comparators made it difficult to draw firm conclusions about the efficacy of surgical over non-surgical management in these patients. Conclusions Operative management of fragility fractures of the pelvis should be considered for patients failing a brief period of non-operative management, however prospective randomised trials need to be performed to provide improved evidence for this intervention. Surgeons should consider which fixation techniques for fragility fractures of the pelvis are robust enough to allow immediate weightbearing, whilst minimising operative morbidity and post-operative complications. PROSPERO Systematic Review ID: CRD42020171237.https://doi.org/10.1186/s12891-021-04579-wOsteoporosisPelvic fracturePelvic ringFragility fracture of the pelvisPercutaneous |
| spellingShingle | Daniel G. G. Wilson Joshua Kelly Mark Rickman Operative management of fragility fractures of the pelvis – a systematic review BMC Musculoskeletal Disorders Osteoporosis Pelvic fracture Pelvic ring Fragility fracture of the pelvis Percutaneous |
| title | Operative management of fragility fractures of the pelvis – a systematic review |
| title_full | Operative management of fragility fractures of the pelvis – a systematic review |
| title_fullStr | Operative management of fragility fractures of the pelvis – a systematic review |
| title_full_unstemmed | Operative management of fragility fractures of the pelvis – a systematic review |
| title_short | Operative management of fragility fractures of the pelvis – a systematic review |
| title_sort | operative management of fragility fractures of the pelvis a systematic review |
| topic | Osteoporosis Pelvic fracture Pelvic ring Fragility fracture of the pelvis Percutaneous |
| url | https://doi.org/10.1186/s12891-021-04579-w |
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